The Next Steps in the Fiscal Year 2014 Budget and Appropriations Process

This week, Department of Health and Human Services (HHS) Secretary Sebelius testified before the House Energy and Commerce Committee on April 18 and before the Senate Finance Committee on April 17 on President Obama's Fiscal Year 2014 (FY14) budget request. She explained the Administration's budget priorities for moving the health of America forward. At the Senate hearing she stated, "The Affordable Care Act, signed into law in March of 2010, is already benefiting millions of Americans, and our budget makes sure we can continue to implement the law. By supporting the creation of new health insurance marketplaces, the budget will ensure that starting next January Americans in every state will be able to get quality insurance at an affordable price."

Next week, she will testify before the House and Senate Appropriations Labor, Health and Human Services subcommittees on April 24 and 25 respectively. She will discuss the Appropriations necessary for FY14 for her department. AIDS United will keep you informed as these hearings progress. AIDS United will continue to advocate for increased funding for the domestic HIV/AIDS funding portfolio.

FY 14 Budget

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The House and the Senate passed separate FY14 budgets that are dramatically different. Senate Budget Committee Chair Patty Murray's (D-WA) budget assumes sequestration is eliminated. House Budget Committee Chair Paul Ryan's (R-WI) budget assumes sequestration remains in place and cuts spending even further. Currently, there is conversation between the two houses about convening a Budget Conference Committee (Conference) to hash out the differences and pass a joint budget resolution. Given the stark differences between the two budgets, including ideological differences, it is not likely that the Conference will convene, let alone come to agreement on a joint budget.

FY14 Appropriations

Senate Appropriations Chair Barbara Mikulski (D-MD) and House Chair Harold Rogers (R-KY) will begin debate and discussion of their Appropriations bills with vastly different top line discretionary (discretionary and non-defense discretionary) spending totals. Sen. Mikulski wants the committee to write appropriation bills to total $1.058 trillion, which assumes sequestration is replaced. Rep. Rogers wants the House committee to write appropriation bills to total $966 billion, which assumes sequestration remains in place. The difference in the 2 approaches is the sequestration amount of $91 billion. For FY14 going forward to FY 2021, sequestration cuts will be met by lowering annual budgetary caps that were set in law by the Budget and Control Act of 2011. Different from sequestration in FY13, there will not be a need for an across-the-board cut to all programs. Congress will have the opportunity to appropriate funding that meets the caps in a more thoughtful manner, albeit under severely reduced budgetary constraints. There will continue to be separate caps for defense and non-defense discretionary spending, but the House has already stated that they will increase defense spending, thereby increasing the pressure on the non-defense discretionary side of the ledger.

Fiscal Year 2013 AIDS Drug Assistance Program/Part C Transfers

AIDS United continues to discuss the importance of the transfer of funding at HHS for the AIDS Drug Assistance Program (ADAP) and Part C World AIDS Day funding. This funding is on the ground now and needs to continue with the Ryan White ADAP 2013 funding. Staff from the Office of Management and Budget has informed us that they are aware of the funding problem and are working diligently to solve the issue. It is always difficult to transfer funding from one program to another, but this year it will be even more difficult since programs are being cut approximately 5% due to sequestration implementation as well as the small percentage cut from the legislation passed in January to delay the start of sequestration until March 1.

Prevention and Public Health Fund Fiscal Year 2013 Allocations

The Department of Health and Humans Services (HHS) has made the 2013 Prevention and Public Health Fund Allocations available to the public. The Affordable Care Act established the Prevention and Public Health Fund to provide expanded and sustained national investments in prevention and public health, to improve health outcomes, and to enhance health care quality through investments in a range of activities, including community and clinical prevention initiatives; research, surveillance and tracking; public health infrastructure; and immunizations and screenings.

This release is the first place we see the real impact of sequestration on this program. The Fund was scheduled to be allocated at $1 billion. The announced allocations total $949 million, which reflects the 5% cut ($51 million) from sequestration. Though 5% sounds like a manageable amount, when you are dealing with a $1 billion program, 5% is real money. We will continue to work with our colleagues to inform Members of Congress about these impacts, but we also urge you to continue to catalog stories that we can use here in Washington, D.C. You can tell your Members in their district offices that sequestration is cutting important programs in all of our communities. You can view the 2013 allocations here.

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